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HomeMy Public PortalAbout5027 SANTA ANITA AVE_Building__ 6A888A 0135-9 2-05 'PP ICATION FOR BUILDING . PERMIT .�. i SION OF BUILDING AND SAFETY BUILDING :• ADDRESS'�. �� I�r:= rF <3. /•C F�=�' �"_ s:: Depmrtnent of Couaty Engineer -County Of LOS Aagelee LOCALITY WM.J.FOX,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS DISTRICT NO. GROUP 8 TYPE BEAR MAPpeFOR APPLICANT TO FILL IN ,05 I CONST. I ADDRESS �i_.t �i[ s NUMABER / HWY YES LOT NO. BLOCK USE ZONE SPECIAL a1-CONDITIONS TRACT 30? 13 14r j q NO.OF SLUGS. BUILDING EXIST. SIZE OF LOT& .i'y®"d I NOW ON LOT SETBACK YARD HWY STREET NAME WIDTH USE OF FRONT t7 EXISTING BLDG. P.L. OWNERSIDE ee 92 P. L. MAIL O TRACT DWELL. I UNIT ADDRESS J��r—�� Qe 5 INDUSTRIAL TEL 1 DWELL. 'I UNIT CITY NO. 6 PU=ALTETC.ARCHITECT OR TEL. 2 DUPLIX 1 UN 7 AD ENGINEER NO. 3 APT. UNITS - 8 M13CEL. ADDRESS. 4 COMMERCIAL TEL. INSPECTION .RECORD CONTRACTOR NO. ADORE58 r • DESCRIPTION OF WORK ADD . ALTER _ REPAIR DEMOLISH FT. NO.OF � NO.OF SIZE S STORIES_ FAMILIES USE OF STRU TUREtst•f d, S •c. _ r SIGNATURE OF. y� B APPLICANT �6e" 4—LE APPROVALS ADDRESS DATE INSPECTOR'S SIGNATURE FOUNDATION:LOCATION $ P.C. S FORMS.MATERIALS FEE FRAME:FIRE STOPS, VALUATION ffi BRACING,BOLTS FEE FURNACE:LOCATION, 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT.DUCTS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH.INT. !J�!`�� •��GNial.[-�+../ AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. �� � /.Civ LATH.EXT. SIGNATURE OF• �� w HOUSE R PERMITTRECT AND POSTEDEE ADDRESS FINAL I'� �s� �r�lr•,.,, WM.J.FOX,COUNTY ENGINEER VALIDATION C.N.DIRL,AM.CHIEF BLDG.INSPECTOR . l�0 3 9. 0 5 MAR R 1\\ 1 0.0 0. �. y� 76A638A CE #803 1/71 APPLICATION FOR BU4LDING PERMIT ! COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING7. ti ADDRESS , COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or type only) CROSS ST. BUILDING DIS�T^RICT N GRO - TYPE P O D B ADDRESS � � �, CONST, STATISTICAL C' A SIFICATION SEVER MAP LOT NO. BLOCK CLASS NO. DWELL.UNITS BK �PL� TRACT f1 USE ZONE[MAPNO.OF BLDGS.SIZE OF LOT X NOW ON LOT CIAL USE OF NDITIONS EXISTING BLDG. TEL OWNER + e a7Lrl . _ �/ NO• BLDG.SETBACK FROM ADDRESS �a2 S + FRONT PROP.LINE OF (STREET) -+ F TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY p HIGHWAY WIDTH FROM C.L. ARCHITECT Pf TEL. ,(• _ ENGINEER NO. BLDG.SETBACK FR ADDRESS SIDE PROP.LINE OF (STREET) } TEL. TYPE OF EXISTING SETBACK HIGHW •}• YARD = TOTAL C CONTRACTOR Np, HIGHWAY WIDTH FROM C.L. C C: ADDRESS LIC. NO. + C LIC. F CITY CLASS CORNER CUTOFF YES ❑ NO ❑ oLL CONSTRUCTION LENDER NAME AND BRANCH �J- SEE REVERSE SIDE FOR SPECIAL APPROVALS E ADDRESS SQ. FT. NO. OF NO. OF NEW ❑ SIZE STORIES FAMILIES USE OF ADD STRUCTURE r ALTER ❑ SIGNATURE REPAIR❑ APPLICAN DEMO ❑ VALUATIONS APPROVALS DATE INSPECTOR4 SIGNATURE LP.C. PMT. FOUNDATION: LOCATION FEE 5 FEE5 'j FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. IC THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF •CALIFO NIA IN R TING TO WORKMEN'S COMPE INSUR NCE LATH, EXT. SIGNATUR HOUSE NUMBER COR- PERMITTE RECT AND POSTED r� -ADDRESS - FINAL �a-�0�71 J1•tjni).';i_r.s.� JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK , M.O. CASH Ar-.0 7 8 1 8 JUN 1 0 1 D 1 7.2 5, � 7GA638A CE 9803 1/71 .APPLICATION FOR BUILDING PERMIT _ COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER ' MAP BOOK PAGE PARCEL • BUILDING AND SAFETY DIVISION BUILDING ADDRESS -5 e 7 COLEMAN W. JENKINS, SUPT OF BUILDINGr LOCALITY FOR APPLICANT TO FILL IN NEAREST Print or type only) CROSS ST. BUILDING „ DIST ICT N U TYPE P ADDRESS ��e> s.0 CONST. STATISTICAL CLASSIF ATION S ER AP LOT NO. : BLOCK I CLASS NO, DWEI I UNITS BK� PG TRACT j USE ZONE MAP NO.OF BLDGS. NO. SIZE OF LOT NOW ON LOT SPECIAL USE OF CONDITIONS EXISTING BLDG. OWNER TEL. NO. BLDG.SETBACK FROM ADDRESS FRONT PROP.LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY HIGHWAY WIDTH FROM C.L. ARCHITECT OR TEL. + _ ENGINEER NO J BLDG,SETBACK M ADDRESS SIDE PROP.LINE OF (STREET) EL. TYPE OF EXISTING SETBACK AY } YARD = TOTAL a CONTRACT HIGHWAY WIDTH FROM C.L. Cc ADDRESS .Z O �••, LIC. L CITY CLAS CORNER CUTOFF YES ❑ NO y, CONSTRUCTION LENDER NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS SQ. FT /r-� NO. OF NO. OF NEW go rz SIZE r? STORI S FAMILIES .71 USE OF ADD ❑ r 4el STRUCTURE ALTER ❑ REPAIR❑ �� ].� SIGNATURE OF APPLICANT r r DEMOL ❑ VALUATIONS >C ' APPROVALS AT IN croR•s G TU RE P.C. PMT. FOUNDATION: LOCATION ) 1 FEE S . j FEES ( +�J !� FORMS, MATERIALS FRAME: FIRE, STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACINGBOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. IC THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF 'CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. LATH, EXT. SIGNATURE OF ~ PERMITTEE HOUSE NUMBER COR- RECT AND POSTED ¢� ADDRESS O' 6F Y6 FINAL yr JOHN F. LEWIS, PRINCIPAL S�CKY. IXL ENGINEER PLAN CHECK VALIDATION CK. ' CASH _ PERMIT VALIDATIONM. CASH Ao 4 6 5.7 r FEB 2 9 2 1 D 8.5 5 � Ao 4 6 5 8"-' FEB 2 9 1 -D 2 8.5 0 7 8 A 6r8 A.0 E#2 'j3:9-88_ ^` APPLICATION F*�`+ ': . :; L®ING ERM 10iA fli 41 COUNTY OF LOS ANGELES �-• :S�G� � � ' DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION : s j Y JOHN A. LAMBIE, COUNTY ENGINEER / u COLEMAN W. JENKINS, SUPT OF BUILDING N FOR APPLICANT TO FILL IN GROUP TYPE PROCESSED BY`� CONS (Print or type only) ti K BUILDINGn�j [CAL CLASSIFICATION SEWER MAP ADDRESS .,5//rL q. '� I 0, OWELL,UNITS� BK PG ze 16 LOT NO, /.g ( OC I 'E MAP ^ �►- NO, d-W TRACT �: . SPECIAL NO.OF BLDGS. ` .-±^r+* CONDITIONS SIZE OF LOT NOW ON LOT r USE OF EXISTING BLDG. „w BLDG,SETBACK FROM OWNER © L TEL. FRONT PROP.LINE OF _(STREET) NO TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. „�`Q� QGL. �. (� , CITY -/ ('/� + BLDG,SETBACK FROM ARCHITECT OR TEL. SIDE PROP.LINE OF (STREET) ENGINEER NO, TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C,L. TEL, J / _ CONTRACTOR L NO. /O/ + C LIC. ♦ c ADDRESS r rj h', NO. / CORNER CUTOFF YES ❑ NO ❑ G CITY � CLASS - SEE REVERSE SIDE FOR SPEC C APP VALS F. CONSTRUCTI N LENDER p NAME AND BRANCHIV ADDRESS SQ, FT, NO. OF NO, OF NEW ❑ �' 'G �� SIZE STORIES FAMILIES USE OFADD o�• O l3 STRUCTURE K ALTER Q ool SIGNATURE OF REPAIR❑ APPLICANT DEMOL ❑ D A r VALUATION$ APPROVALS DATE _ INSPEfiTOR'5 SIGNATURE P.C. PMT, FOUNDATION: LOCATION •FEE$ a FEE$ FORMS, MATERIALS FRAME: FIRE STOPS, !® 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS jm.. STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CALIFORNI N RELATING TO r' WORKMEN'SCOMPEN TION RA LATH, EXT, f �� s'--'°'-?.•+9.-- SIGNATURE OF + HOUSE NUMBER COR- RECT AND POSTED 'ADDRESS �le c ' FINAL JOHN F. LEWIS. PRINCIPAL STRRAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION gy M.O. CASH �.nn„ 6 c 9 -9%ca 11"'Ay20 1 D 2 2.50- cc '8A633A 066.3 8.88 •- APPLICATION FOR BUILDING PERMIT 1 DIVISION OF BUILDING AND SAFETY BADDRDESB ING 50 / /1��(.(A17►�. �/r Department of County Engineer County of Loa Angeles LOCALITY J WM.J.FOX,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT of BUILDING CROSS ST. l DISTRICT O. GROUP TYPE SEWER MA BK PG FOR APPLICANT TO FILL IN J� I cowsT. STATE j/ � NUMBER yYBUILDING YES NOADDRESS �/I LOT NO. r BLOCK USE NE SPECIAL r CONDITIONS TRACT 3 lw'g A%� �n ,,/ ,� I NO.OF BLDGS. SETBACK YARD HwY STREET NAME WIDTH SIZE OF LOT T NOW..LOT USE CF�r FRONT EXISTING BLDG. P.L. !/ L / I DO OWNER ! [ P . �.�f./�Lr I� AIDE MAIL ADDRESS f(„K r O TRACT DWELL. 1 UNIT 5 INDUSTRIAL > CITY TEL. DWELL. I UNIT 6 PUBLIC BLDG. ��.. NO. ARCHITECT OR TEL. 2 DUPLEX I UNIT 7 ADDN..ALT.. ETC. ENGINEER NO. 3 APT. UNITS iSCEL: ADDRESS 4 COMMERCIAL % TEL INSPECTION RECOAD CONTRACTOR NO. 9 /` _ADDRESS Y~LTF X / DESCRIPTION OF WORTS ! EW ADD . i ALTER. .REPAIR DEMOLISH �C4-".1A1 ���� �p�V.ST SQ. FT. NO.OF SIZE RIES FAMILIES USE OF STRUCTURE �,� ,, 0 SIGNATURE OF j {`L 2fZ / �/ I/�JL.CU( C`jC1 APPLICANT � APPROVALS ADDRESS,. DATE INSPECTOR'S.SIGNATURE P.C. S FFORMS,rMATERIALSION:LOCATION q �� FEE FRAME: FIRE STOPS. r` r VALUATION � $ BRACING,BOLTS 3�aI 'Sfo vrG� Answaam REE FURNACE:LOCATION, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT,DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH,INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. / LATH,EXT. ��/I1 Af SIGNATURE of I' //Ar! HOUSE NUMBER O PERMITTEE r (} RECT AND PAS '0 ADDRESS P /J ADDRESS r•'� ,,iy/� J—OI FINAL WM.J.FOX,COUNTY ENGINEER VALIDATION C.N.D RLAM,CHIEF BLDG. INSPECTOR LXo2 9 3 2"Ub. X 1 6 1 6.00 .awasawooe.aa-aAPPLICATION FOR BUIL®ING PERMIT 1 DIVISION OF.BUILDING AND SAFETY ADDRESS BUILDING tZ rJ A& Department Of County Engineer County Of LOS Angeles LOCALITY a/ ' o _ WM.J.FOX.COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP TYPE SEWS MAP BK PG FOR APPLICANT TO FILL IN I CONST. I WILDINGADDRESS 2 SS = 4 / 12 ' 14--. Q Jck.- _ N MA ER�O— STATE YES NO) LOT NO. BLOCK .. USE ZONE• SPECIAL CONDITIONS TRACT NO.OF S W SIZE OF LOT NOW ON LOTBUILDING YARD HY STREET NAME EXIST. SETBACK WIDTH USE OF FRONT I EXISTING BLDG.. P.L. Z Cl 1 PP10 A90 OWNER 14* - f[ SIDE MAIL /I ADDRESSO . TRACT DWELL. 1 UNIT 5 INDUSTRIAL CITY .�.C.,ry�A/7 C� { mac/ _ NO. DWELL. f UNIT 6 PUBLIC BLDG. 2 DUPLEX f UNIT 8 MISCEL. ARCHITECT OR TEL. 7 ADON. ALT. ETC. ENGINEER NO. 3 APT. UNITS ADDRESS 4 COMMERCIAL TEL. INSPECTION RECORD _CONTRACTOR Lno"t 0_7 NO. i ADDRESS DESCRIPTION OF WORK _ NEW ADDALTER REPAIR l '� SQ. FT. NO.OF N OF / SIZE STORIES FAMILIES USjO�F STRUCTURE. SIGNATURE OF �t �� r G APPROVALS APPLICANT 6G�_ ADDRESS -��� DATE INSPECTOR-SSIGNATURE. FOUNDATION:LOCATION P.C. g FORMS.MATERIALS FEE FRAME: FIRE STOPS. r' t:5- -O BRACING.BOLTS VALUATION FEE FURNACE: LOCATION., — R 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT.DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT / AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES' LATH.INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. LATH.EXT. SIGNATURE OF 1�Ja i HOUSE.N NS O � - PERMITTEE nil '` •" L- :2c— or/��r RECT AND PfCiB ADDRESS FINAL / '7`ly ��H WM.J.FOX,COUNTY ENGINEER VALIDATION .N. DIRLAM.CHIEF BLDG. INSPECTOR 'E AP 4 7 .6 0' APR- 4 1 2.0 0 to A MAMA CC eops/.. APPLICATION FOIA BUILDING,PERMIT .� COUNTY OF LOS ANGELES BUtLDiNG -0. o DEPARTMENT OF COUNTY ENGINEER' ADDRESS `S BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE,-COUNTY ENGINEER. NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTT ICT NO.. GROUP TYPE R SED BY CONST. ADU'LDDRESS. ' STATISTICAL CLASSIFICATION. S ER MAPS C-5—No.�DWELL.UNITS `� LOT NO. BLOCK MAP NUMBER H TE. YES N TRACT , USE ZONE SPECIAL /INO CONDITIONS OWONSIZEOF LOT N LOT USE OF EXISTING BLDG. BUILDING EXIST. • EL. YARD HWY STREE NAME . . SETBACK WIDTH OWNER I NO. L FRONT ADDRESSt7^Dd/�C.Q.fi6t/L! W_( .Y•�1�G[j:I�ci SIDE r B SCJ ARCHITECT OR TEL. P•I-• ENGINEER . NO. INSPECTION RECORD ' n - ADDRESS � TEL. .ri iI(/.vp U CONTRACTOR- NO. ADDRESS. Al R/J r-, DESCRIPTION OF WORK A%✓r1 � O H NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO.OF NO.OF SIZE STORIES FAMILIES, N USE.OF e' STRUCTURE mia SIGNATURE OF APPLICANT VALUATION$ zoo.® � I , }' APPROVALSPMT P / �/DA�TE / INSPECTOR'S SJI/GNATURE/, F E '$ I FEE $ �'J r— FOFORMS.MATERIALSON !'d'� ! �I✓I,fG,ra.ytJ FRAME:FIRE STOPS, l I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- BRACING BOLTS PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND FURNACE:LOCATION, GAS VENT DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION.. I CERTIFY- THAT IN DOING THE WORK AUTHORIZED I LATH,INT. WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE WORKMEN'S COMPENSATION LAWS .OF CALIFORNIA. LATH;EXT. SIGNATURE ' HOUSE NUMBER COR' PERMITTEV f RECT AND POSTED ADDRESSOCA .2 FINAL CLYDE N. DIRLAM, PRINCIPAL STRyVe�T1{RAL ENGINEER PLAN CHECK VALIDATION cK. M.O. CASH PERMIT VALIDATION, `(cit, M.O. CASH s 76A698A CE 9809 1./71 ' APPLICATION FOR BU 1 I NG PEFeAlT COUNTY OF LOS ANGELES ASSESSAR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING _ ADDRESS�Q COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY it FOR APPLICANT TO FILL IN NEAREST Print or tvoe onl CROSS ST, q. BUILDING �. DIST' (f/�ICT Njr?FrEP¢$t O S BY ADDRESS a� CONST. STATISTICAL CLASSI ICATION SEWER MAP LOT NO. BLOCK CLASS NO.-34DWELL.UNITS BK PG TRACT (jJ USE ZONE MAP -r NO.OF BLDGS. NO. SIZE OF LOT NOW ON LOT SPECIAL USE OF If 4 CONDITIONS EXISTING BLDG. TEL. OWNER NO. BLDG.SETBACK FROM ADDRESS FRONT PROP.LINE OF - (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY HIGHWAY JNIDTH FROM C.L. ARCHITECT OR TEL. :1+ ENGINEER NO. BLDG,SETBACK FRZYM ADDRESS SIDE PROP.LINE OF (STREET) 07rEL o TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL C CONTRACT HIGHWAY WIDTH FROM C.L. L ADDRESS NIC ff_4 + LIC. IC- ❑ L CITY CLASS S:3 CORNER CUTOFF YES ❑_ No _ u. CONSTRUCTION LENDER va NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS z ADDRESS SQ. FT. NO. OF NO. OF NEW SIZE S DRIES FAMILIES USE OF ADD ❑ ' STRUCTURE i ALTER ❑ � Q/ SIGN URE OF REPAIR❑ ` p' APPLICANT 000, ,r DEMOL ❑ vQ VALUATIONS V V v s APPROVALS DATE IflSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEES J ,✓ FEE$ • FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS .AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF •CALIFORNIA IN RELATING TO -- - WORKMEN'S COMPENSATION INSURANCE. LATH, EXT, SIGNATURE OF HOUSE NUMBER COR- - - PERMITTEE RECT AND POSTED ADDRESS FINAL .JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATIOCK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH i�il;o 4 N 13 2 3 17 1 0 7UG36A CENS033-66 .APPLICATION F R BUILONG -PERMI-T. IJ COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS c3(�02 BUILDING AND SAFETY DIVISION LOCALITY ` JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINSA P-T OF BUILDING 'CROSS ST. DISTRICT N ROU TYPE, PR ESS Y FOR APPLICANT TO FILL IN Q CONST. BUILDING STA.TISTI.CAL CLASSIFICATION SEWER MAP ADDRESS 02 "CDouble Drive .�+ 3 �' B,K PG LASS NO. DWELL UNITS LOT NO. BLOCK U �ONE NOP c a TRACT 33 J SPECIAL N0. OF SLOGS. CONDITIONS SIZE OF LOT � NOW ON LOT USE OF Residence BLDG. SETBACK FROM Malone FRONT PROP. LINE OF TREET) OWNER r M lO a NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = •TOTAL ADDRESS 5027 Double Drive HIGHWAY WIDTH I'ROM C.L. CITY Tem le City. California �L) I I + - a RCHITECT OR TEL. BLDG. 9E.TBACK FROM A ENGINEER NO. SIDE PROP. LINE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS L HIGHWAY WIDTH FROM C.L. CONTRACTOR Monarch RoofinTOL S1 6-61 1 + G LIC CORNER CUTOFF YES NO C ADDRESS 6 NO C CITY LIC _ SEE REVERSE SIDE FOR SPECIAL APPROVALS °c DESCRIPTION OF WORK #20 - r ` NEW ADD ALTER REPAIR DEMOLISH SQ.FT. NO. OF NO. OR SIZE STORIES -FAMILIES USEOF STRUCTUREnMpn shingles SIGNATURE OF. APPLfCANT VALUATION$ 0 I 0 APPROVALS DATE' INSPECTOR'S SIGNATURE P.C. PMT. 1'FOUNDAT.ION, LOCATION FEE$ FEE$ 6.00 FORMS, MATERIALS _ FRAME, FIRE STOPS'. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS- AND OLT 'AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 'FURNACE: LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS ' 9UILDING CONSTRUCTION. I CERTIFY THAT. IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. ' TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION URANCE. LATH. EXT. SIGNATURE OFA Al 7.J HOUSE NUMBER COR- RECT AND POSTED ADDRESS F 1 NAL ;,-•..W/o�_"�z'nep", JOHN F. LEWIS. PRINCIPAL STRAL ENGINEER CK. • PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION M.D CASH' ,.y- %LFA8 1r. �.;APS.2.0 1 D 6.00 COUNTY OF LOS ANGELES- TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY /'LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9706110004 PHONE: (818) 285-0488 EXT: -LEGAL� : NO. UP CUN3T NEW BUILDINGDDR S : TR: 13363 LT: 16 SQ. FT STORIES TYPE OCCUP GROUP 5027 SANTA ANITA AV STRUCTURE: 552 2 V R3 TEMP'CA 917803618 ASSESSOROR 0 NUMBER: GARAGE: 110 1 NEAREST-C.ROSS STREET: 8574-009-017 OTHER: THOMAS PAGE, 597 GRID: D4 LOCALITY: TEMPLE CITY TENANT: S DG . am ZONE: D 0 : ... SSE BY: EXPIRES EXIST OCC GRP: 08/04/97 TC 08/04198 OWNER: TEL. NO: SLOGS. NOW ON LOT: VALUATION: FI AL DATE FINAL CODE: MARTINEZ RAYMOND A;RAFAELA (818) 442-6645- 1 43,490 5027 SANTA ANITA AV TEMP 917803618 FEES PAID ESCRIPT-ION OF WORK 1ST FLOOR ADDITION OF FAMILY ROOM AND 3/4 BATH, 2ND FLOOR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ADDITION OF DEN. ATTACH EXISTING GARAGE TO EXISTING DWELL- APPLICANT: , SAME AS OWNER - B1 PLANCHECK W/ENERGY 43490.00 VAL 670.12 AA BLDG PERMIT ISSUANCE G NOTION RESID 27.75 SPECIAL CONDITIONS: AC 43490.00 VAL 4.35 B2 PERM17 W/ENERGY11,' ��=' 43490:00 VAL 788.37 `TOTAL FEES 1,490.59 CONTRACTO • TEL. N0: APPR A INSPECTOR SI NAT SAME AS OWNER - �� i LIC. NO 0 D SETBACKS .==„�y�'`,��,�s,•, � `;y� -',�� SOILS ENGINEER APPROVAL ARCHITECT0 G ER: E 0: << ' 1 "�� =r �, �` t ! _ 0 DA 0 RE C FORS LIC. N0: l �' SLAB/UNDER FLOOR ( . _ RAISED FLOOR FUME MAP.NO: SEWER 14AP BOOK: FIRE ZONE: CMP: UNOERFLOOR INSULAT ON 3 01 IST;LEVEL FEW H 0. OF FAN LIE G S: CO D: STAT CLAS97 NO 21 ND :LEVEL-FLOOR SHEATH SCHOOL WITHIN. HAZARDOUS SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT . REQUIREDTOTAL SETBACKS BLDG. P INSPECT SET BACK YARD: HWY: -PROP LINE: WIDTH:' U47 FRONT PL- ` `' S EAR PANELS SIDE PL- G44 1 ` S IO A STR INTERIOR LATH/DRYWALL EXTERIOR LATH 10� LOT DRAINAGE SMOK5 DETECTIONDEVICES ' FIRE DEPARTMENT APPRO AL % * ADDITIONAL DATA ON FILE REPORT ID: DPR261 ROUTE TO: BS0508 APPLICATION FOR OUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WOfiKER'S COMPENSATION DECLARATION - FOR APPLICANT TO FILL IN' BUILDING ADDRESS I.hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS O or a certificate,pf Workers'Compensation Insurance,or a certified 7 5R H'f q /sJ copy thereof(61c.3800,Lab.C.) CITY ZIP LOCALITY Policy No. Company SIZE OF LOT, NO.OF BLDG&NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNE TEL NO. YES NO COMPENSATION INSURANCE �A r,,,Pft.L A` �Y1A"�L IiG - Ole WITHIN 1000 FT OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDR SS d92 7 94"-f*- *14-f 4'+�- DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) � CITYZIPAs I certify that in the performance of the work for which this permit � . �� t O res is issued; I shall not employ any person in any manner so as to �+S �,F, r become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. -2/ DWELL UNITS NOTICE 7D APPLICANT.• If, after making this Certificate of REQUIRED' TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9SEWER MAP >_(commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES a Professions Code,and my license is in full force and effect. NEW ❑ BK PG U License Number Lic.Class DES ION OF WORK ADD VALUATION Contractor Date ALTER 11 $ a'Z 'S'iiI,�edU W ❑ I am exempt under Sec. Z REPAIR ❑ $ z BAP.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EX;rG BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm# +� 1 as owner of the property, or my employees with wages as ZO ' their sole compensation, will do the work and the structure is ADDRESS ?:i•E ° not intended or offered for sale (Section 7044, Business and FINAL DATE Q _,;;_'�: LII,a`tl Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL +• M "r OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE d. ❑ I, as owner Of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY > _ licensed contractors to construct the project (Section 7044, YES NO❑ T j`�.i '•= Business and Professions Code.) WILL THE INTENDED USEOF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 1 i•i i 4 d,_8C OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH i e E HL e a '..P-- CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINESI-1d " 1-.3 j� I hereby affirm that there is a construction lending agency for YES❑ NO❑ C4 the performance of the work for which this permit is issued(Sec. CHANGEa S I I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING N 3097,CIV.C•) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. TITLE 2.CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. oLender's Address C gvNEfl OR AGENT ' o I certify that I have read this application and state under penalty 4 f H1111.7 G of perjury that the above information is correct.I agree to comply P.C.FEE V D PERMIT FEE cm with all county ordinances and State laws relating to building ;S construction,and hereby authorize representatives of this County ISSUANCE FEE ��. ato an upon the above-men• ned property for inspe tion purposes. INVESTIGATION FEE TOTAL FEE J seen.o m a.a�l or gpe„i 1. an. SEE REVERSE FOR EXPLANATORY LANGUAGE